Corruption Threatens Health

A major agenda item for the upcoming Global Fund Board Meeting is a report by Office of the Inspector General (OIG) “on investigations on ‘fraud and abuse’ (investigations of potential fraud, misappropriation, corruption or mismanagement), audits on internal control processes, functional reviews and assurance validation.” A current article at the BBC provides a broader context in which these concerns arise:

The Kenyan government has said it could be losing nearly one-third of the national budget to corruption. Finance ministry officials told a parliamentary committee the losses could be nearly $4bn (£2.5bn) a year. They said individuals were taking huge sums meant for development projects.

In a 2006 article The Economist wrote cynically that, “scandals are as regular as Africa’s tropical rains,” when reporting on Kenyan scandals at that time. Often the same leader who vowed to fight corruption are later “exposed for theft and rotten dealings of his own.”

BBC noted last month after four Kenyan government officials were accused of several million dollars of fraud that, “Kenya, generally seen as one of Africa’s more stable and prosperous countries, is also one of its most corrupt.” and explained that the most recent corruption perception index from watchdog Transparency International (TI) shows Kenya placed a joint 154th, along with war-torn nations or those recovering from conflict such as Congo, Cambodia and Guinea Bissau.”

Then earlier this year the BBC reported that, “Kenyans are becoming increasingly angry with their politicians as corruption and deepening rifts in the coalition government threaten the country’s peace. International donors have suspended some funding because money is being siphoned off before it reaches the projects it is intended for.”

But back to the OIG … The OIG, which was set up in 2005, submitted a report dated September 2009 outlining a variety of problems with Global Fund operations that may not be actual acts of corruption, but leave the door wide open to the possibility of fraud. Such problems include conflict of interest among members of the Central Coordinating Mechanisms (CCMs), lack of auditing, monitoring and oversight capacity and procedures by CCMs for Principal Recipients (PRs) and of Sub-Recipients (SRs) by PRs, procurement and logistics management irregularities, and excessive top-up salaries for PR and SR officials (who often are also government employees). Some of the OIG report findings on Kenya include …

  • inefficiencies with in-country financial management systems resulted in significant delays in program implementation
  • monitoring and evaluation systems were ineffective
  • the CCM was not performing oversight functions properly
  • non-transparent selection and funding of civil society organization recipients
  • late and inaccurate reports

The Standard News was a bit more blunt about Kenya’s predicament earlier this year. Dann Okoth reported that, “Kenya stares a major health crisis in the face amid donor uncertainty, poor management, corruption and apathy. Possible grant freeze and shifting donor priorities could critically affect HIV and Aids, tuberculosis (TB) and malaria programmes and compromise millions of lives, it has emerged. But it is Kenyans’ own inefficiency, corruption and impunity that would be the final nail on the coffin of a well thought out health plan gone terribly awry.”

The Standard’s reporter also bemoaned the lack of transparency from either the Kenyan Government or the Global Fund about where the country should be in terms of funding and implementation of grants. He also observed that, “of 144 countries receiving the grants, Kenya is ranked 110th in terms of average grant rating as at November 2008.” This, he implied may not be unconnected to the rejection of Round 8 and 9 Global Fund applications.

The Human Rights Advocacy Forum highlighted the plight of TB patients who depend on Global Grants for their regular drug supply. They reported that, “The procurement by the ministry is fraught with irregularities, including not adhering to procurement regulations, procuring of goods not required and substandard goods at inflated prices,” and observed that “Kenya Medical Supplies Agency (KEMSA), responsible for the procurement, storage and distribution of drugs on behalf of the government, was investigated for corruption and its CEO was sacked in October 2008.”

Obviously Kenya is not the only challenge to the OIG and the Global Fund. Other countries have had grants suspended including Uganda and Zambia. What is surprising is that such practices have been going on for so long with so little obvious response. Corruption kills just as easily as the viruses, bacteria and parasites that the Global Fund was created to fight.

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